Hepatopancreatoduodenectomy for advanced biliary malignancies
Abstract. Background:. Hepatopancreatoduodenectomy (HPD) has been considered the only curative treatment for metastatic cholangiocarcinoma and some locally advanced gallbladder cancers (GBCs). However, HPD has not yet been included in treatment guidelines as a standard surgical procedure in consider...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2022-12-01
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| Series: | Chinese Medical Journal |
| Online Access: | http://journals.lww.com/10.1097/CM9.0000000000002067 |
| _version_ | 1797840220726493184 |
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| author | Xiangsong Wu Maolan Li Wenguang Wu Xu’an Wang Huaifeng Li Runfa Bao Yijun Shu Jun Shen Jun Gu Xuefeng Wang Wei Gong Shuyou Peng Yingbin Liu Yanjie Yin Xiuyuan Hao |
| author_facet | Xiangsong Wu Maolan Li Wenguang Wu Xu’an Wang Huaifeng Li Runfa Bao Yijun Shu Jun Shen Jun Gu Xuefeng Wang Wei Gong Shuyou Peng Yingbin Liu Yanjie Yin Xiuyuan Hao |
| author_sort | Xiangsong Wu |
| collection | DOAJ |
| description | Abstract. Background:. Hepatopancreatoduodenectomy (HPD) has been considered the only curative treatment for metastatic cholangiocarcinoma and some locally advanced gallbladder cancers (GBCs). However, HPD has not yet been included in treatment guidelines as a standard surgical procedure in consideration of its morbidity and mortality rates. The aim of this study was to evaluate the safety and effectiveness of HPD in treating biliary malignancies.
Methods:. The medical records of 57 patients with advanced biliary cancer undergoing HPD from January 2009 to December 2019 were retrospectively retrieved. A case-control analysis was conducted at our department. Patients with advanced GBC who underwent HPD (HPD-GBC group) were compared with a control group (None-HPD-GBC group). Baseline characteristics, preoperative treatments, tumor pathologic features, operative results, and prognosis were assessed.
Results:. Thirteen patients with cholangiocarcinoma and 44 patients with GBC underwent HPD at our department. Significant postoperative complications (grade III or greater) and postoperative pancreatic fistula were observed in 24 (42.1%) and 15 (26.3%) patients, respectively. One postoperative death occurred in the present study. Overall survival (OS) was longer in patients with advanced cholangiocarcinoma than in those with GBC (median survival time [MST], 31 months vs. 11 months; P < 0.001). In the subgroup analysis of patients with advanced GBC, multivariate analysis demonstrated that T4 stage tumors (P = 0.012), N2 tumors (P = 0.001), and positive margin status (P = 0.004) were independently associated with poorer OS. Patients with either one or more prognostic factors exhibited a shorter MST than patients without those prognostic factors (P < 0.001).
Conclusion:. HPD could be performed with a relatively low mortality rate and an acceptable morbidity rate in an experienced high- volume center. For patients with advanced GBC without an N2 or T4 tumor, HPD can be a preferable treatment option. |
| first_indexed | 2024-04-09T16:11:22Z |
| format | Article |
| id | doaj.art-8fe6387053bd423b8cd999ac45446680 |
| institution | Directory Open Access Journal |
| issn | 0366-6999 2542-5641 |
| language | English |
| last_indexed | 2024-04-09T16:11:22Z |
| publishDate | 2022-12-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Chinese Medical Journal |
| spelling | doaj.art-8fe6387053bd423b8cd999ac454466802023-04-24T10:04:20ZengWolters KluwerChinese Medical Journal0366-69992542-56412022-12-01135232851285810.1097/CM9.0000000000002067202212050-00011Hepatopancreatoduodenectomy for advanced biliary malignanciesXiangsong WuMaolan LiWenguang WuXu’an WangHuaifeng LiRunfa BaoYijun ShuJun ShenJun GuXuefeng WangWei GongShuyou PengYingbin LiuYanjie YinXiuyuan HaoAbstract. Background:. Hepatopancreatoduodenectomy (HPD) has been considered the only curative treatment for metastatic cholangiocarcinoma and some locally advanced gallbladder cancers (GBCs). However, HPD has not yet been included in treatment guidelines as a standard surgical procedure in consideration of its morbidity and mortality rates. The aim of this study was to evaluate the safety and effectiveness of HPD in treating biliary malignancies. Methods:. The medical records of 57 patients with advanced biliary cancer undergoing HPD from January 2009 to December 2019 were retrospectively retrieved. A case-control analysis was conducted at our department. Patients with advanced GBC who underwent HPD (HPD-GBC group) were compared with a control group (None-HPD-GBC group). Baseline characteristics, preoperative treatments, tumor pathologic features, operative results, and prognosis were assessed. Results:. Thirteen patients with cholangiocarcinoma and 44 patients with GBC underwent HPD at our department. Significant postoperative complications (grade III or greater) and postoperative pancreatic fistula were observed in 24 (42.1%) and 15 (26.3%) patients, respectively. One postoperative death occurred in the present study. Overall survival (OS) was longer in patients with advanced cholangiocarcinoma than in those with GBC (median survival time [MST], 31 months vs. 11 months; P < 0.001). In the subgroup analysis of patients with advanced GBC, multivariate analysis demonstrated that T4 stage tumors (P = 0.012), N2 tumors (P = 0.001), and positive margin status (P = 0.004) were independently associated with poorer OS. Patients with either one or more prognostic factors exhibited a shorter MST than patients without those prognostic factors (P < 0.001). Conclusion:. HPD could be performed with a relatively low mortality rate and an acceptable morbidity rate in an experienced high- volume center. For patients with advanced GBC without an N2 or T4 tumor, HPD can be a preferable treatment option.http://journals.lww.com/10.1097/CM9.0000000000002067 |
| spellingShingle | Xiangsong Wu Maolan Li Wenguang Wu Xu’an Wang Huaifeng Li Runfa Bao Yijun Shu Jun Shen Jun Gu Xuefeng Wang Wei Gong Shuyou Peng Yingbin Liu Yanjie Yin Xiuyuan Hao Hepatopancreatoduodenectomy for advanced biliary malignancies Chinese Medical Journal |
| title | Hepatopancreatoduodenectomy for advanced biliary malignancies |
| title_full | Hepatopancreatoduodenectomy for advanced biliary malignancies |
| title_fullStr | Hepatopancreatoduodenectomy for advanced biliary malignancies |
| title_full_unstemmed | Hepatopancreatoduodenectomy for advanced biliary malignancies |
| title_short | Hepatopancreatoduodenectomy for advanced biliary malignancies |
| title_sort | hepatopancreatoduodenectomy for advanced biliary malignancies |
| url | http://journals.lww.com/10.1097/CM9.0000000000002067 |
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